Dry Needling/ “Dry” Trigger Point Injections for Muscle Pain: What the Evidence Says

Dry needling has gained significant attention in recent years. But what exactly is dry needling, how does it work, and what does science say about its efficacy? Here's a comprehensive look at this increasingly popular technique.

What Is Dry Needling? 

 
Dry needling is a minimally invasive procedure in which a thin, solid (filiform) needle is inserted directly into myofascial trigger points — those tight, painful knots that develop within muscles.[1][2] Unlike trigger point injections, no medication or solution is injected; the needle itself is the treatment. The term "dry" simply means no liquid is used.[1] 
 
Trigger points are a hallmark of myofascial pain syndrome, a condition characterized by localized muscle pain, tenderness, and referred pain patterns.[1] These trigger points can develop from muscle overuse, injury, stress, or poor posture, and they are a frequent source of neck pain, back pain, shoulder pain, and headaches. 

 

How Does Dry Needling Work? 

 
When a needle is inserted into a trigger point, it mechanically disrupts the abnormal muscle tissue. This often produces a "local twitch response” a brief, involuntary contraction of the muscle fibers. This twitch response is generally considered a sign that the trigger point has been effectively targeted.[1] 
 
Several mechanisms are thought to explain why dry needling relieves pain: 
 

  • Disruption of dysfunctional motor endplates: The needle breaks up the taut bands of muscle fibers that form the trigger point.[1][3] 

 

  • Activation of pain-modulating pathways: Needling may stimulate descending inhibitory neural pathways and trigger the release of endogenous opioids, the body's natural painkillers.[4] 

 

  • Local biochemical changes: Research suggests that dry needling can reduce concentrations of pain-related chemicals (such as substance P and calcitonin gene-related peptide) in the tissue surrounding trigger points.[1] 

What Does the Research Say? 

 
 
The evidence base for dry needling has grown substantially. Multiple systematic reviews and meta-analyses have examined its effectiveness: 
 

  • Short-term pain relief is well-supported. An umbrella review of 36 systematic reviews found that dry needling is superior to sham or no intervention for short-term pain reduction across all body regions. It was also found to be equally effective to other physical therapy interventions for short-term pain.[5] 

 

  • Effects may extend beyond the short term. A large meta-analysis of 42 randomized controlled trials found a large effect on pain reduction within 72 hours (SMD = −0.81), a moderate effect at 1–3 weeks (SMD = −0.69), and large effects persisting at 4–12 weeks (SMD = −0.85) and even 13–24 weeks (SMD = −0.81), though the quality of evidence was low to moderate.[6] 

 

  • Combining dry needling with other therapies may enhance results. Several studies have shown an additional treatment effect when combining dry needling with physiotherapeutic interventions compared to those interventions alone. A randomized controlled trial of 130 patients with chronic neck pain found that deep dry needling combined with stretching was significantly more effective than stretching alone, with benefits lasting up to 6 months.[5][1] 

 

  • Trigger point injections may offer an edge for some patients. Some evidence suggests that trigger point injections with local anesthetic (such as lidocaine) may provide greater pain relief than dry needling alone, particularly in the medium term. However, trigger point injections did not show superiority over dry needling for outcomes like disability, range of motion, or depression.[1][3] 



Is Dry Needling Safe? 

 
Dry needling is generally considered safe when performed by a trained practitioner. A 2026 systematic review and meta-analysis examining adverse events found that minor side effects — such as soreness at the needle site, bruising, and temporary pain — are common, occurring in up to about 48% of individual treatments.[7] However, serious complications are rare, occurring in less than 0.5% of treatments.[7] Potential serious adverse events include pneumothorax (if needling near the thorax), nerve injury, vascular injury, and infection. 

 



References 

  1. Myofascial Pain Syndrome: An Update on Clinical Characteristics, Etiopathogenesis, Diagnosis, and Treatment. Steen JP, Jaiswal KS, Kumbhare D. Muscle & Nerve. 2025;71(5):889-910. doi:10.1002/mus.28377. 
  2. AAPM&R Position Statement on Dry Needling. American Academy of Physical Medicine and Rehabilitation (2012). 
  3. Use of Corticosteroids for Adult Chronic Pain Interventions: Sympathetic and Peripheral Nerve Blocks, Trigger Point Injections - Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, and the International Pain and Spine Intervention Society. Benzon HT, Elmofty D, Shankar H, et al. Regional Anesthesia and Pain Medicine. 2025;:rapm-2024-105593. doi:10.1136/rapm-2024-105593. 
  4. Non-Pharmacological and Non-Surgical Treatments for Low Back Pain in Adults: An Overview of Cochrane Reviews. Rizzo RR, Cashin AG, Wand BM, et al. The Cochrane Database of Systematic Reviews. 2025;3:CD014691. doi:10.1002/14651858.CD014691.pub2. 
  5. Clinical Effectiveness of Dry Needling in Patients With Musculoskeletal Pain-an Umbrella Review. Chys M, De Meulemeester K, De Greef I, et al. Journal of Clinical Medicine. 2023;12(3):1205. doi:10.3390/jcm12031205. 
  6. Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis. Sánchez-Infante J, Navarro-Santana MJ, Bravo-Sánchez A, Jiménez-Diaz F, Abián-Vicén J. Physical Therapy. 2021;101(3):pzab070. doi:10.1093/ptj/pzab070. 
  7. Frequency and Severity of Adverse Events Associated with Dry Needling: A Systematic Review and Meta-Analysis. Rabanal-Rodríguez G, Simón-Alonso MA, Navarro-Santana MJ, et al. Physical Therapy. 2026;:pzag050. doi:10.1093/ptj/pzag050.